Northwest Missouri State University - DOC 2

							                                                        Northwest Missouri State University
                      APPLICATION FOR STUDENT EMPLOYMENT – GENERAL
                                           Departments of Art and Music – Fine Arts Building 101
 Return this application to: Fine Arts Office, DeLuce Fine Arts
 Building (room 101), or e-mail to brendam@nwmissouri.edu                                 Date of Application:
 Incomplete applications will NOT be considered.                                          Date Available To Begin Work:

Personal Data: (please print)

Name:                                                                                                               919#
          (Last)                              (First)                    (Nickname)           (Middle)

Local/Campus Address:
                                (Street)                                 (City)                    (State)              (Zip)

Permanent Address:
                                (Street)                                 (City)                    (State)              (Zip)

Local/Cell Phone:                                   Permanent Phone:                          University E-mail (S#):


Have you ever worked for the University before? If so, what was your job title, where, and when:
List any relatives presently employed by Northwest:

 You may work no more than a total of 20 hours per week with all campus jobs through the NW Student Employment Program.
 You MUST be enrolled in six (6) hours or more of academic credit each trimester that you work.
 Graduate students who have received assistantships are not eligible for other NW student employment positions.


Which department are you applying to for a job:                   Art     Music       Have you received Federal Work-Study?      Yes       No

What position(s) are you applying for (be specific):

Hours available to work per week:                         Which trimesters are you available to work?        Fall       Spring         Summer

Education:

Class:      Freshman        Sophomore                        Junior       Senior        Graduate        NW GPA:
Course of Study (major/minor):                                                            Date of NW Graduation (sem/year):

Skills:
Describe your academic and work-related experiences as well as other employment skills in further detail which qualify you for the
position(s) for which you are applying:

Hobbies:

Campus honors, activities, and organization memberships:

Do you anticipate involvement in any other activities (i.e. organizations, sports, rehearsals, educational observations, practicums,
student ambassadorships, other employment, etc.) that might conflict with your work schedule? If yes, please explain:
Employment History: (list most recent position first)

1.    Employer:                                                                    Dates of Employment:
      Type of Business:                                                            Supervisor’s Name:
      City and State:                                                              Phone:
      Job Title and Duties:
      Reason for Leaving:
2.    Employer:                                                                    Dates of Employment:
      Type of Business:                                                            Supervisor’s Name:
      City and State:                                                              Phone:
      Job Title and Duties:
      Reason for Leaving:

Schedule:
Please fill in your class schedule below (include all classes, other employment, activities, etc.) You may indicate any special
preference for working hours as desired.

                         Monday                      Tuesday                  Wednesday                    Thursday                      Friday
       8:00
       9:00
      10:00
      11:00
      12:00
       1:00
       2:00
       3:00
       4:00
     Evenings
     5:00 pm
     6:00 pm
     7:00 pm
     8:00 pm

Are you available:              Saturday afternoon             Saturday evening              Sunday afternoon             Sunday evening

PLEASE READ CAREFULLY - By inserting my name (as written above) in the text field below, I certify that the above statements are correct. I understand
that any false information (or omissions) in the application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination
without notice. I agree that all rules, orders, and regulations of the Board of Regents affecting my employment shall constitute a part of my appointment or
employment. I further understand that Northwest Missouri State University has the right to review my education, previous employment, driving and criminal
records and other background data.


Please re-type your name here (this is a proxy for your signature):

Date (MM/DD/YYYY):


                                     Northwest Missouri State University is an equal opportunity employer.